Thesis (Ph.D.) - University of Queensland, 2005. / Includes bibliography.

Thesis (Ph. D.)--Drexel University, 2006. / Includes abstract and vita. Includes bibliographical references (leaves 118-128).

Dissertation (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2006. / Vita. Bibliography: pp. 193-208.

Structural changes in the frontal and temporal lobes and in subcortical white matter tracts often occur following closed head injury (CHI). In contrast to this well delineated structural pathology, the post-traumatic cognitively-related functional changes in these and other brain regions have not been adequately described. To characterize the long-term functional neuroanatomy of CHI, the present study compared regional cerebral blood flow (rCBF) patterns in 13 severely-injured, well-recovered, unmedicated patients to those from 13 well-matched healthy controls. rCBF was measured using oxygen-15 water intravenous bolus positron emission tomography (PET) while subjects performed the Wisconsin Card Sorting Test (WCST), an indicator of prefrontal lobe functioning that involves matching stimuli to a changing sorting principle based on external feedback, and a Cued Recall Memory Test (CRMT), which involves remembering semantically-related word pairs. The neuropsychological tasks were used to provoke specific neural systems believed to be important in task performance (the prefrontal cortex in the former, the hippocampus in the latter). Subjects also performed two specially designed sensorimotor control tasks to provide measures of baseline rCBF. Given the controversy regarding the statistical analysis of PET data, a two-pronged method was utilized: 1) Statistical Parametric Mapping, the state-of-the-art technique that examines rCBF throughout the entire brain, and 2) region of interest analysis, an anatomically-based method for examining rCBF in a limited set of brain regions. Between-group rCBF differences were tested in the four tasks separately and also in the two neuropsychological tasks after subtracting baseline rCBF (i.e., rCBF activation). To characterize the relationship between cerebral perfusion and behavior, correlations were performed between performance and rCBF activation (i.e., task-control) for each group separately, and between rCBF activation and an index of current neuropsychological functioning for the CHI patients. Analyses of each task separately revealed that, compared to controls, CHI patients showed lower rCBF in anterior cingulate cortex (ACC) and subcortical areas. Analyses of rCBF activation data revealed: 1) increases in left inferior frontal gyrus (including Broca's area) and left hippocampus of CHI patients relative to control subjects during the WCST, 2) a negative correlation between task performance and the right hippocampus during the WCST in CHI patients, and 3) correlations between the hippocampus and performance during the CRMT in the CHI patients that were in the opposite direction to those found in the control subjects. These neurofunctional changes are compatible with the structural and cognitive sequelae of CHI First, given a hypothesized role of the ACC in attentional processes, reduced rCBF in this region of CHI patients may relate to the persistent and often subtle difficulties in attention after CHI, whereas rCBF diminutions in subcortical regions may relate to diffuse damage to or deafferentation of subcortical regions in this CHI sample. Second, given similar (although slightly, but not significantly, poorer) performance on the WCST by the CHI patients, increased left prefrontal cortical activity may partially reflect behavioral compensation (e.g., subvocalization to aid memory during the task) and also physiological compensation for inefficiencies in other brain areas (e.g., subcortical regions). Finally, in light of the relatively poorer task performance of CHI patients (non-significant tendency in the WCST but highly significant in the CRMT), differences between the groups in the direction of the correlations between performance/cognition and hippocampal activation may suggest disorganization of hippocampal functioning in CHI patients. This exploratory and descriptive investigation identifies brain structures with post-traumatic changes that may be important to cognition. These results may provide evidence of both behavioral and neurophysiological compensation in patients with severe CHI. / Graduate

M.Tech.

Very little information exists about the acute presentation of overuse injuries specific to cycling. Although there are studies, mainly in the form of surveys, that do detail the incidence and prevalence of overuse injuries in cyclists or triathletes, they all take place weeks or even months after events or focus on a 1 year injury history. (Weiss 1985, Korkia et al. 1994, Wilber 1995, Manninen and Kallinen 1996 and Salai et al. 1999) The aim of this study was to describe the historical data obtained when patients presented to the Student Chiropractic Sports Council at the Pick ‘n Pay 94.7 Cycle Challenge from the years 2002 to 2004. The focus of the study was on the profile of injuries with which patients presented. This was a descriptive study of historical data obtained by students treating at the Pick ‘n Pay 94.7 Cycle Challenge from the year 2002 to 2004. The data was acquired in the form of SOAP (Subjective, Objective, Assessment, Plan) notes held by the Student Chiropractic Sports Council. The results of this study showed that the most common location of complaints were the anterior and posterior thigh. Musculotendinous strains were by far the most predominant injury with the hamstring being involved more commonly (33.8%) than any other muscle. Overall 72.8% of patients were diagnosed with musculotendinous strains. Further, the results also showed that 55.8% of patients complained of eck or back pain and 59.7% were diagnosed with cervical facet joint, thoracic facet joint, lumbar facet joint or sacroiliac joint dysfunction. / Dr. S. Wilcox Dr M. Moodley

M.A. / As medical technology and procedures continue to improve, traumatically brain injured persons who previously would not have lived through their injuries are managing to survive. The traumatically brain-injured person must learn to cope with the profound physical, cognitive, emotional, and personality changes that are produced from brain trauma. Within the family system, the members reciprocally influence one another. Major events that occur within the family system have an immense effect on the family relationships, dynamics, roles, and expectations. A traumatic brain injury, with its sudden onset and the inherent uncertainty regarding recovery and rehabilitation, can have a devastating effect on the family as a whole, and upon its individual members. Research on the familial effects of a member’s traumatic brain injury portrays a bleak image of the family in the aftermath of TBI, and for years afterwards. Grief, anger, guilt, blame, loneliness, depression, and isolation are often reported in the literature. The literature focuses mainly on the primary caregiver, usually the spouse of the TBI person, or the parent of a TBI child. Limited research has been conducted regarding the psychological effects on the offspring of parents who sustain traumatic brain injuries. Surely, children and adolescents will feel the effects of a parent’s brain injury differently than a spouse would. However the actual experience as perceived by the offspring has been neglected in research thus far. Adolescents were the focus of the current study. Being in a time of transition between childhood and adulthood, it was thought that they would experience the effects of a parental brain injury differently than younger children or adults within the family would. The existential-phenomenological approach employed as the research methodology allowed for a rich, in depth understanding of the adolescents as beings-in-the-world interpreting their own experiences of having a traumatically brain-injured parent. Six adolescent offspring of traumatically brain-injured parents were sourced from Headway Gauteng, and interviewed for the study. The four interviews that were used for the intense phenomenological analysis were transcribed verbatim. Themes were derived from the experience of each participant, and then integrated and related to the relevant available literature and within the wider context of existential phenomenology, in order to arrive at an in-depth understanding of the adolescent experience of a parent’s traumatic brain injury. The phenomenon of parental traumatic brain injury in the lifeworlds of the adolescents was characterized by numerous themes. Adolescents experienced (to varying degrees) denial, anger, grief, guilt, and anxiety. There was a tendency towards overprotectiveness of the injured parent, resulting in the parentification of the adolescents. Loneliness and a sense that nobody could understand their feelings were particularly strong themes, perhaps exacerbated by the importance of conformity during the adolescent period. Furthermore, the adolescents experienced drastic changes in their lives following their parents’ traumatic brain injuries. Not only were family roles and dynamics affected, but also the adolescents reported extensive changes in themselves. There were sudden increases in their responsibilities alongside a sense that they were forced to mature sooner than their peers. The adolescents coped using both approach and avoidance styles of coping. Religion was a theme in the lives of all four adolescents. Despite the professed negative impact of the experience of having a traumatically brain-injured parent, the adolescents in the current study managed to find some degree of positive meaning in having to cope with such a traumatic event and its consequences. Professionals working with brain-injured clients and their families will find value in the present study. The in-depth description of the experience of adolescents with brain-injured parents will be helpful in planning support programmes and interventions following familial brain injuries. The findings of this study have also been the basis for recommendations for future empirical investigations.

Magister Chirurgiae Dentium (MChD) / The literature shows that maxillofacial fractures in children are uncommon. Although the Department of Oral and Maxillofacial Surgery of the Faculty of Dentistry, of the University of the Western Cape, has been providing a service to the Red Cross Children’s Hospital (RXH) for the past twenty years, no study had been undertaken to determine the age, gender, number of patients per year, aetiology, patterns, and management of maxillofacial fractures at this institution. A retrospective records based study was undertaken to determine these features. This study accessed the records of patients seen at the trauma unit at RXH, from 1994 to 2003 inclusive, and referred for maxillofacial attention. One-hundred-and-five patient records were obtained and analyzed using the SPSS statistic package. One-hundred-and-twenty-seven fractures were recorded in one hundred and five patients. The age of the patients ranged from one to thirteen. Sixty-five male and forty female patients were seen. Dentoalveolar fractures were the most common fracture seen in both the midface and mandible. Midface fractures were more common than mandibular fractures. Falls, followed by motor vehicle accidents, were the most common cause of facial fractures. Most fractures were successfully managed by closed procedures. At this institution, nasal and frontal fractures have surprisingly little or no input from the Department of Oral and Maxillofacial Surgery. / South Africa

M.A. (Psychology) / The Post Traumatic Amnesic Syndrome, which follows a mild closed head injury, seems to be a common occurrence in the field of neuropsychology. The syndrome is primarily characterised by a transient memory loss of daily events, normally commencing within days after the injury. The symptoms include absent-mindedness, an inability to remember names, dates, numbers and faces, commands and orders given at work. Due to the relatively uncomplicated nature of a mild closed head injury, the syndrome is often overlooked and underestimated in terms of its intensity and psychological damage. Patients are sent home after a brief observation period and medical staff are of the opinion that the patients will recover successfully, without experiencing much psychological or cognitive strain. It is usually thought that the syndrome does not last for more than three to four months. The aim of the research was to determine the nature of the experience of not being able to remember daily events, as part of the post traumatic amnesic syndrome. The influence of the syndrome on the patients' support persons was also investigated

Purpose: Trigger points may occur when muscle is subject to direct trauma, sustained tension, fatigue, radiculopathy, joint dysfunction and emotional stress, which may cause aberrant nerve conduction and dysfunction of the motor neurons. Any of these factors may increase the possibility of overload stress to a muscle and may convert a latent trigger point to an active one. In humans, due to muscle attachments, spinal manipulation causes reflex relaxation of associated and distal musculature. The purpose of this study was to assess the effects of upper cervical spine manipulation, specifically C1, on pain tolerance of trigger points over the erector spinae muscles in show-jumping horses. Method: This study consisted of two groups, the experimental and the control group, each consisting of ten horses. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. The only method of treatment that was administered to each horse was chiropractic manipulation to the most restricted side of the UPPER CERVICAL SPINE joint complex, from which the objective findings were based. Procedure: Both groups were examined for trigger points within the Erector Spinae muscles and these trigger points were assessed, via an algometer, for spot tenderness. All horses were then examined for a cervical restriction of the upper cervical spine. Only the experiment group had the restriction corrected by a chiropractic manipulation and thereafter both groups were reassessed two minutes later, and then again two weeks later, via an algometer, for spot tenderness within the same trigger points. Results: Statistically significant changes were found when comparing the algometer readings before the adjustment with the algometer readings after the adjustment on the right. Otherwise no statistically significant differences were found when comparing algometer readings before the adjustment with the algometer readings after the adjustment on the left, or when comparing the algometer readings before the adjustment with the algometer reading two weeks later bilaterally. Conclusion: The results were inconclusive with regards to immediate and prolonged effects of upper cervical spine manipulation, specifically C1, on pain tolerances over the erector spinae muscle. As this study was directed to a small group of subjects, accurate conclusions cannot be formulated due to the insignificant findings obtained from the study and further research needs to be performed on the effects of upper cervical spine manipulation on trigger points in horses. / Dr. Ashleigh Deall Dr. Alex Niven Dr. Chris Yelverton